Thursday, July 10, 2014

Healthcare Professionals Do Burn Out

Patients, for the most part, are comfortable in their belief that the healthcare professional they are currently seeing is well-schooled, competent, secure and will provide excellent care. The last thing they think about is the mental health problems of these professionals because, in their minds, these professionals know how to take care of themselves. Thinking this way would be a mistake and, if you're a healthcare professional, you need to begin to do some re-thinking about yourself and what you need to do for you.

A bit of  perusal of the current statistics available for some of the health professions is quite enlightening.  Perhaps these statistics hold the key to one aspect of professional healthcare burnout, especially in the nursing area.  The Bureau of Labor Statistics (2004) has recently updated their original estimate of a shortage of nurses (2002) of 800,000 needed.  Now, the problem has escalated and it is estimated that in 2012 we were already 1 million short of the nurses needed and things may become even gloomier.

When you have this type of nurse shortage, it's inevitable that you are going to begin to see changes in the whole character of nursing, the workload of nurses, the disruptions in their personal and professional lives and feelings of diminished effectiveness on their part.  This doesn't mean that nurses aren't any more qualified or don't work just as hard.  What it does mean is they are being pushed to the limit and everyone will pay a price.  It goes without saying that as our population ages and the need for nursing care escalates we need to look at how we can manage this demanding situation in much better ways. One way is to keep nurses healthy.

Physicians, too, are experiencing varying rates of burnout at different stages of their careers.  Medical school is no longer what it once was and there are dramatic changes that can be seen on the medical education horizon.  Not only will physicians be expected to be proficient in the use of new technologies, including computers and various modes of communication and even Google Glass, they will be expected to be up to speed immediately.  How much will this take away from their ability to devote their attention to their patients?

One study looked at an incredibly large sample of physicians in all specialties in various stages of their careers and evaluated satisfaction for over 89,000 of them.  Among the various measures that were taken was one for burnout.  Physicians in the middle stage of their careers were seen at greatest risk for burnout than those at the beginning or late stages of their careers.  Burnout, in fact, the researchers surmised may have led to a number of physicians leaving practice and retiring earlier than they had anticipated. Then, of course, we also now have physicians remaking themselves into business professionals or attorneys or some area outside of clinical practice.

Whether we are talking about nurses, physicians or others in the healthcare professions, we are still looking at a serious problem that either may remain hidden or realized and unaddressed.  Interestingly enough, while physicians at middle career were experiencing negative emotions regarding their profession, nurses who had just begun their careers were at greatest risk.  There may be a variety of social status factors still at play here, even though nurses have seen their future prospects broadened into independent practice and other areas of  medical practice.  Nurse practitioners are taking a greater role in family medicine as we see a decline in the number of family physicians in the United States.

I have had doctoral students whose primary day job was in counseling surgical residents who had run afoul of the hospital administration and their chiefs of service. Why would a surgeon suddenly throw a scapel at someone in the OR or barricade a nurse from entering? Irrational and dangerous and it results in remediation if the hospital catches it quickly enough. Six years in a high stress residency can certainly bring this behavior out in many people and surgeons do deal with dangerous instruments every day.

Burnout is measured in a number of ways, but there are some standard scales that are used in its measurement.  One scale that was used for a sample of physicians noted that the cycle that leads to burnout is characterized by three distinct symptoms:

1. Physical and emotional exhaustion where the physician feels drained, worn out by the level of work required and unable to recover after periods of downtime.

  2.  A sense of depersonalization where they develop a cynical attitude toward their patients and the patient's concerns regarding their health.  I wonder if this is where they begin to put that annoying abbreviation, PIA (pain in the ass)  into charts.  The physician becomes sarcastic and cynical and almost sees patients as adversaries or an interference in their life.

3.  A reduced sense of personal adjustment and an increase in their perception of their work as being somehow negative.  It's almost a "hands thrown in the air" reaction and a sense of helplessness.

One statistical analysis of physicians found that 45.8% of them had at least one symptom of burnout. What do some physicians, especially psychiatrists, do when the burnout leads to a high degree of depression?  Unfortunately, the result may be suicide and, in fact, physicians have a rate of suicide that is two times higher than the national average and they are more successful at it.  Psychiatrists are, regrettably, the highest medical specialty in the suicide statistics for physicians.  Female physicians appear to have higher rates of suicide than male physicians and, again, this may be due to medical cultural differences.

Those who care for the mental and physical health of others, therefore, appear to have an incredible inability to recognize impending, catastrophic difficulties in themselves. In the evaluation of these statistics we must take into consideration the fact that many physician suicides are not listed as such on death certificates.  Often, the certificate will contain something more palatable than suicide which provides a level of comfort for the family.   For this and other reasons, insureance benefits being one, we may not truly know the extent of physician suicide nor which specialties really do have the highest rates.

Overall, the bulk of the research on healthcare professionals' burnout points to factors including work and family or social life integration, interests outside medicine (yes, there's a fishing seminar for dentists), all the usual lifestyle things anyone needs to include in their activities; exercise, sleep, adequate diet and laughter.

Medical care isn't the be-all and end-all and anyone in the field shouldn't let it be the death of them either emotionally or physically. Everyone deserves a life and especially those who strive to help others in their lives.